title: Holmium laser urethrotomy for treatment of traumatic stricture urethra: a review of 78 patients.
abstract: OBJECTIVE
  To evaluate the efficacy and long-term results of laser urethrotomy as minimally invasive treatment for traumatic stricture urethra.
  
  
  METHODS
  Between January 2006 and June 2008, 78 male patients were treated with Holmium Laser urethrotomy. 16 Fr urethroscope was used through which 600um laser fiber was introduced through side channel. Stricture was visualized and incised at 12 o'clock position with energy set at 1500-2000 MJ at pulse rate of 10-12. Two other incisions were given at 2 and 10 o'clock positions. Further ablation was done till 16Fr Foley's catheter was passed. Patients were followed in a stricture clinic.
  
  
  RESULTS
  Patients age ranged from 15-73 years. All strictures were due to trauma, Road traffic accident in 40 (52%) post catheter trauma 4 (5%), fall as ride 27 (35%) and failed urethroplasty 7 (8%). Site of stricture was bulbar 57 (73%), bulbomembranous 16 (20%) and membranoprostatic 5 (2.5%). Length of stricture ranged from 0.8-2.5 cms. At 3 months follow-up, 60 (77%) patients remained catheter and symptoms free while 18 (23%) developed recurrence of stricture but at the end of 36 months follow-up success rate decreased to 47 (60%). Among those who developed re-strictures, 6 ( 7.6%) had 2nd sitting laser while 4 (5.1%) had urethroplasty, and others were on intermittent dilatation. Immediate complications were sepsis 10 (13%), extravasation 2 (4%), failed urethrotomy 2 (4%) and mild haematuria 3 (5.8%). Hospital stay ranged from day care to 3 days.
  
  
  CONCLUSIONS
  Laser urethrotomy is minimally invasive and an effective treatment for short strictures in bulbarurethra. The recurrence rate is 40% in the long-term follow-up and is more commonly seen in completely obliterated strictures.
authors.affiliation: Sindh Institute of Urology and Transplantation (SIUT), Karachi.
authors.forename: Manzoor
authors.initials: M
authors.lastname: Hussain
authors.forename: Murli
authors.initials: M
authors.lastname: Lal
authors.forename: Syed Hasan
authors.initials: SH
authors.lastname: Askari
authors.forename: Altaf
authors.initials: A
authors.lastname: Hashmi
authors.forename: Syed Adibul Hasan
authors.initials: SA
authors.lastname: Rizvi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D053844:Lasers, Solid-State; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D016896:Treatment Outcome; D014521:Urethra / Q000293:injuries* / Q000601:surgery*; D014525:Urethral Stricture / Q000209:etiology / Q000601:surgery*; D055815:Young Adult